What do you tell a respected colleague and friend when the tragic death of their patient is more than they can stand? One of the best intensivists I know shared with me the heart breaking story of withdrawing medical care on a toddler run over by a car. The child’s catastrophic injuries left him close to brain dead on admission to his quiet six bed PICU, and there was nothing he could have done to change the inevitable outcome. Yet, he was devastated and shared with me that he could no longer handle that part of the job. My friend had worked in a high intensity PICU for many years until emotional fatigue led him to a more mellow job in a lower acuity unit. In his new job he no longer had to care for senseless traumas, shaken babies, or  heart disease unamenable to treatment. He was supposed to see asthma and pneumonia and simple post-surgical patients. His young patients were supposed to get better.

Ironically, he taught me when I was in training how to withdraw life sustaining care with love and compassion. I still hear his words of advice in my head whenever I give Ativan or morphine to stave off air hunger during a terminal extubation. Maybe he was too good at his job. Each death a doctor presides over chips away at his or her soul one piece at a time until after awhile, that part of them becomes unrecognizable. I think my friend and teacher had seen too much death, too much tragedy, and he had finally recovered a piece of himself in a quieter, kinder setting.  But then this little boy struck by a car blindsided him and his peaceful PICU. His respite from the stream of daily tragedies had softened his heart and left him open to devastating pain of the death of a child again, and he cried for the boy. His tears are testimony to his compassion and humanity. He is an amazing critical care doctor.